Key result
Post-ACS cardiovascular events are linked to ~4.3-fold higher sudden death risk.
Why the study?
Little is known about the long-term incidence and influence of cardiovascular events before sudden death among stabilized patients after ACS.
Does the occurrence of subsequent cardiovascular events increase the risk of sudden death in stabilized patients after acute coronary syndrome?
Observational (n=18,144)
Double-blind (parent trial)
Stratified randomization (parent trial)
Yes
Does the occurrence of subsequent cardiovascular events increase the risk of sudden death in stabilized patients after acute coronary syndrome?
In patients stabilized after ACS, subsequent cardiovascular events such as myocardial infarction or heart failure significantly increase the long-term risk of sudden death.
Answers are grounded in this paper and cite their sources.
Subsequent events after ACS stabilization identify higher-risk patients; leaves open whether targeted prevention reduces sudden death.
Background Unlike patients with low ejection fraction after an acute coronary syndrome (ACS), little is known about the long-term incidence and influence of cardiovascular events before sudden death among stabilized patients after ACS. Methods and Results A total of 18 144 patients stabilized within 10 days after ACS in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) were studied. Cumulative incidence rates (IRs) and IRs per 100 patient-years of sudden death were calculated. Using Cox proportional hazards, the association of ≥1 additional postrandomization cardiovascular events (myocardial infarction, stroke, and hospitalization for unstable angina or heart failure) with sudden death was examined. Early (≤1 year after ACS) and late sudden deaths (>1 year) were compared. Of 2446 total deaths, 402 (16%) were sudden. The median time to sudden death was 2.7 years, with 109 early and 293 late sudden deaths. The cumulative IR was 2.47% (95% CI, 2.23%-2.73%) at 7 years of follow-up. The risk of sudden death following a postrandomization cardiovascular event (150/402 [37%] sudden deaths; median 1.4 years) was greater (IR/100 patient-years, 1.45 [95% CI, 1.23-1.69]) than the risk with no postrandomization cardiovascular event (IR/100 patient-years, 0.27 [95% CI, 0.24-0.30]). Postrandomization myocardial infarction (hazard ratio [HR], 3.64 [95% CI, 2.85-4.66]) and heart failure (HR, 4.55 [95% CI, 3.33-6.22]) significantly increased future risk of sudden death. Conclusions Patients stabilized within 10 days of an ACS remain at long-term risk of sudden death with the greatest risk in those with an additional cardiovascular event. These results refine the long-term risk and risk effectors of sudden death, which may help clinicians identify opportunities to improve care. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00202878.
No takes yet. Share an insight, caveat, or question.
Fordyce et al. (2022) conducted an observational in Acute coronary syndrome (stabilized within 10 days) (n=18,144). Postrandomization cardiovascular event (myocardial infarction, stroke, hospitalization for unstable angina, or heart failure) vs. No postrandomization cardiovascular event was evaluated on Sudden death (HR 4.32, 95% CI 3.46-5.39, p=<0.001). Postrandomization cardiovascular events increased sudden death risk in stabilized ACS patients (HR 4.32, 95% CI 3.46-5.39; IR 1.45 vs 0.27 per 100 patient-years).
Synapse has enriched 10 related papers. Consider them for comparative context: